Debut de diabetes inmunomediada secundaria a inmunoterapia en paciente con cáncer urotelial: Reporte de caso
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https://doi.org/10.5281/zenodo.15634907Palabras clave:
Neoplasias Ureterales, Carcinoma de Células Transicionales, Cetoacidosis Diabética, Diabetes Mellitus Tipo 1, InmunoterapiaResumen
Paciente masculino de 58 años, monorreno quirúrgico con antecedente de cáncer urotelial de alto grado en tratamiento con inmunoterapia y múltiples comorbilidades, desarrolló una cetoacidosis diabética con características de síndrome hiperosmolar tras administración de segunda dosis de Nivolumab. Ingresó con hiperglicemia severa, acidosis metabólica, cetonemia, hiperkalemia y falla renal aguda, siendo tratado exitosamente con insulinoterapia intensiva y rehidratación. Evolucionó favorablemente y es dado de alta con esquema de insulina subcutáneo y seguimiento ambulatorio. En vista de ser una entidad poco reportada en Chile, para la que no se cuentan con protocolos actualizados, se realizó revisión de literatura para una comprensión cabal de la incidencia, presentación clínica y manejo de esta patología.
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[1] Dudzińska M, Szczyrek M, Wojas-Krawczyk K, Świrska J, Chmielewska I, Zwolak A. Endocrine adverse events of nivolumab in non-small cell lung cancer patients-literature review. Cancers (Basel) [Internet]. 2020;12(8):2314. Available from: http://dx.doi.org/10.3390/cancers12082314
[2] Zekić T, Benić MS. Anti-programmed death-1 inhibitor nivolumab-induced immune-related adverse events: hepatitis, renal insufficiency, myositis, vitiligo, and hypothyroidism: a case-based review. Rheumatol Int [Internet]. 2023;43(3):559–65. Available from: http://dx.doi.org/10.1007/s00296-022-05247-5
[3] Stamatouli AM, Quandt Z, Perdigoto AL, Clark PL, Kluger H, Weiss SA, et al. Collateral damage: Insulin-dependent diabetes induced with checkpoint inhibitors. Diabetes [Internet]. 2018;67(8):1471–80. Available from: http://dx.doi.org/10.2337/dbi18-0002
[4] Mae S, Kuriyama A, Tachibana H. Diabetic ketoacidosis as a delayed immune-related event after discontinuation of nivolumab. J Emerg Med [Internet]. 2021;60(3):342–4. Available from: http://dx.doi.org/10.1016/j.jemermed.2020.09.023
[5] DailyMed - OPDIVO- nivolumab injection [Internet]. Nih.gov. [cited 2025 May 16]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f570b9c4-6846-4de2-abfa-4d0a4ae4e394
[6] Godwin JL, Jaggi S, Sirisena I, Sharda P, Rao AD, Mehra R, et al. Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic lung cancer. J Immunother Cancer [Internet]. 2017;5(1). Available from: http://dx.doi.org/10.1186/s40425-017-0245-2
[7] Chen X, Affinati AH, Lee Y, Turcu AF, Henry NL, Schiopu E, et al. Immune checkpoint inhibitors and risk of type 1 diabetes. Diabetes Care [Internet]. 2022;45(5):1170–6. Available from: http://dx.doi.org/10.2337/dc21-2213
[8] Zhou L, Yang S, Li Y, Xue C, Wan R. A comprehensive review of immune checkpoint inhibitor-related diabetes mellitus: incidence, clinical features, management, and prognosis. Front Immunol [Internet]. 2024;15:1448728. Available from: http://dx.doi.org/10.3389/fimmu.2024.1448728
[9] American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: Standards of care in diabetes-2025. Diabetes Care [Internet]. 2025;48(Supplement_1):S27–49. Available from: http://dx.doi.org/10.2337/dc25-S002
[10] Ishiguro A, Ogata D, Ohashi K, Hiki K, Yamakawa K, Jinnai S, et al. Type 1 diabetes associated with immune checkpoint inhibitors for malignant melanoma: A case report and review of 8 cases. Medicine (Baltimore) [Internet]. 2022;101(35):e30398. Available from: http://dx.doi.org/10.1097/MD.0000000000030398
[11] Gauci M-L, Laly P, Vidal-Trecan T, Baroudjian B, Gottlieb J, Madjlessi-Ezra N, et al. Autoimmune diabetes induced by PD-1 inhibitor-retrospective analysis and pathogenesis: a case report and literature review. Cancer Immunol Immunother [Internet]. 2017;66(11):1399–410. Available from: http://dx.doi.org/10.1007/s00262-017-2033-8
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Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
